Anesth Pain Med. 2018 August; 8(4):e80184. doi: 10.5812/aapm.80184.

Published online 2018 August 25. Research Article

Effect of Glucose Containing Crystalloid Infusion on Maternal

Hemodynamic Status After Spinal Anesthesia for Cesarean Section
Simin Atashkhoei 1 , Reyhaneh Abri 1, * , Bahman Naghipour 2 , Pouya Hatami Marandi 3 and Mohammad
Taher Fazeli Danesh 2
1
Department of Anesthesiology and Critical Care, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
2
Department of Anesthesiology and Critical Care, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
3
Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
*
Corresponding author: Assistant professor, Department of Anesthesiology and Critical Care, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences,
Tabriz, Iran. Tel/Fax:: +98-4135539163, Email: reyhane.abri@gmail.com

Received 2018 June 04; Revised 2018 August 14; Accepted 2018 August 17.

Abstract

Background: Despite preventive strategies, hypotension is the most common complication of spinal anesthesia in cesarean sec-
tion.
Objectives: The aim of this study was to assess the effect of glucose-containing crystalloid infusion on maternal hemodynamic
status after spinal anesthesia for cesarean section.
Methods: In this prospective, randomized, double-blind clinical trial, 80 parturients undergoing elective cesarean section with
spinal anesthesia were studied. In group A (n = 40) ringer with 1% glucose solution (10 gr glucose in 1000 mL ringer) and in group B
(n = 40) only ringer solution infused before and after spinal anesthesia. Demographic data, hemodynamic change, complications
and their treatments, maternal blood sugar level and neonatal APGAR (appearance, pulse, grimace, activity and respiration) score,
intraoperative fluid, duration of surgery, and anesthesia were recorded in the two groups.
Results: The incidence of hypotension in group A was significantly lower than group B (27.5% vs 75%) (P = 0.002). Other complica-
tions (sustained hypotension, nausea, pallor, and shivering were significantly lower in parturients of the group A (P < 0.05). Mater-
nal blood sugar (BS), before and after surgery, was not significantly different in the two groups (P = 0.207 and P = 0.239, respectively).
There was no statistically significant difference in the APGAR score of neonates at the 1st and 5th minutes of the birth between the
two groups (P = 0.076).
Conclusions: It seems that adding 1% glucose to crystalloid solution improves the hemodynamic status and decreases post-spinal
anesthesia complications without significant changes in the maternal blood sugar level and APGAR score of neonates.

Keywords: Glucose, Crystalloid, Hemodynamic, Spinal Anesthesia, Cesarean Section

1. Background
Regional anesthesia is one of the most common meth-
ods used during cesarean section (1). Hypotension, due
to sympathetic block, is the most common side effect of
spinal anesthesia in cesarean section and can lead to severe
injuries (2-4). Even with preventive approaches, its preva-
lence is 80% - 100% in parturients undergoing cesarean sec-
tion (5-7).
Hypotension decreases cerebral blood flow and may
lead to side effects such as nausea, vomiting, decreased
consciousness, as well as respiratory and cardiac depres-
sion in the mother. Moreover, severe and sustained hy-
potension can reduce the uteroplacental blood flow and
ultimately lead to fetal acidosis and depressed APGAR score
(8-12).
Although crystalloid fluid preload is widely used to
prevent and treat post-spinal anesthesia hypotension, its
efficacy is not certain (9, 13-18). Studies suggest that rapid
crystalloid infusion before spinal anesthesia causes rapid
redistribution of fluid and secretion of atrial natriuretic
peptide (ANP). Therefore, its peripheral vasodilation effect
causes a rapid elimination of the preloaded volume. Ad-
ministration of colloidal fluids for the prevention of post-
spinal anesthesia hypotension is more effective than crys-
talloid fluids in some studies (13-15).
In a study, maternal cardiac output stability with col-
loidal solutions infusion (hydroxyethyl starch containing
1% dextrose) was better than crystalloid solutions. How-
ever, Yorozu et al. (17), did not find a statistically significant
difference in comparison of preloading infusion of col-
loids vs ringer lactate in the prevention of post-spinal anes-
thesia hypotension in parturients undergoing cesarean
section.
Today, it is advisable to use oral or intravenous glucose-

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cited
 Atashkhoei S et al.
containing solutions to provide maternal and fetal en-
ergy and accelerate the progress of labor (18, 19). In a
review study, preoperative carbohydrate administration
improved recovery, accelerated gastrointestinal function,
and reduced hospitalization time without postoperative
side effects in patients undergoing various surgical proce-
dures (20).
Glucose decreases maternal and fetal ketone bodies
that are produced due to mother’s long-term fasting dur-
ing delivery (21).
Intravenous glucose-containing solutions may also re-
duce fetal arterial acidemia and hypercarbia and increase
maternal and embryonic energy (22). It seems to prevent
post-operative hypoglycemia and may not affect the AP-
GAR (appearance, pulse, grimace, activity, and respiration)
scores and the acid-base balance of the umbilical artery
(23).
Recent studies have shown the benefits of administer-
ing colloidal fluid containing glucose 1% before or immedi-
ately after spinal anesthesia to improve the hemodynamic
status of the mother under cesarean section (24-27). Al-
though some satisfactory effects of perioperative glucose
administration have been demonstrated in some studies,
there is no certain data to indicate the effect of glucose-
containing crystalloid infusion on the maternal hemody-
namic. The current study was hypothesized to evaluate
these effects.
2. Methods
After approving the ethics committee of Tabriz
University of Medical Sciences, the proposal has been
registered in the Iranian center of the clinical trials
(IRCT201702077013N17; http://www.irct.ir).
In this double-blind randomized prospective clinical
trial, the prevalence of hypotension after spinal anesthesia
was considered as a primary outcome. According to Arora
et al. (27), the prevalence of hypotension in the control
group was 67%, with α = 0.05 for the first type of error and
power of β = 0.80 for detecting the difference of 32% reduc-
tion in the incidence of hypotension after spinal anesthe-
sia, 80 specimens were estimated. A total of 80 pregnant
women in the age ranges of 18 - 40 years, with American So-
ciety of Anesthesiologists (ASA) class I, with singleton term
(> 37 weeks of gestational age) pregnancy who were candi-
dates for the elective cesarean section with spinal anesthe-
sia enrolled in the study.
They were randomly allocated into two groups of A
and B using Random list software. A total of 40 parturi-
ents enrolled in each group. The informed consent form
was achieved from all women before beginning the study.
Demographic charectristics including age, weight, height,
2 Anesth Pain Med. 2018; 8(4):e80184.
body mass index (BMI), cause of cesarean section, and
number of pregnancies were recorded.
The exclusion criteria were body mass index (BMI) > 35
kg/m2 , any coexisting systemic disease, contraindications
of spinal anesthesia, history of glucose intolerance, drug
history of glucose metabolism affecting drugs, bleeding
more than 1000 cc, and fetal problems.
In the operating room, the standard monitoring was
done including non-invasive blood pressure (NIBP), elec-
trocardiogram (ECG), and pulse oximetry (SPO2 ). The par-
turients in group A (n = 40) received 1% glucose containing
ringer serum, which was prepared by adding 10 g of glu-
cose to 1000 mL ringer before and during operation. Group
B (n = 40) only received the ringer serum.
In both groups, before spinal anesthesia, 8 mL/kg intra-
venous bolus serum infused in 15 minutes and after spinal
anesthesia, infusion continued by 15 - 20 mL/kg/hr until the
end of surgery.
In both groups, spinal anesthesia was performed in sit-
ting position, in L3 - L4 or L4 - L5 intervertebral space by nee-
dle quincke 25 gaged. A total of 2.2 mL solution (10 mg (2
mL) Hyberbaric bupivacaine 0.5% plus 20 micrograms fen-
tanyl) injected intrathecally.
Surgical incision was performed when the sensory
block level of T4 was achieved by the same surgeon in all
patients.
An anesthesiologist managed the anesthesia and the
second anesthesiologist who was not aware of the study
group collected the data. Intraoperative fluid volume, du-
ration of surgery, and anesthesia and maximum sensory
block level were recorded.
Systolic blood pressure (SBP), diastolic blood pressure
(DBP), mean blood pressure (MBP), and heart rate (HR)
were recorded until the end of the operation. SPO2 and ECG
were monitored continuously.
All the spinal anesthesia induced complications in-
cluding hypotension, bradycardia, nausea and vomiting,
agitation, shivering, pallor, respiratory depression, and de-
creased consciousness were recorded.
In case of hypotension (SBP < 100 mmHg or decrease
of more than 25% of baseline), 5 - 20 mg ephedrine or 50
- 200 µg phenylephrine were injected intravenously. Sus-
tained hypotension defined as failure to respond to a sin-
gle dose of vasopressor. Bradycardia (heart rate less than
50 beats/min) was treated with a dose of 0.02 mg/kg at-
ropine. A total of 1 mg of midazolam was injected to treat
agitation and 5mg metoclopramide was injected for treat-
ing nausea and vomiting.
Respiratory support was done in case of decreased con-
sciousness and respiratory depression (SPO2 < 90%).
The 1st and 5th minutes APGAR score were recorded.
In addition to the above, the total dose of vasopressors
 Atashkhoei S et al.

and maternal blood sugar (BS) values before and after the
140

Systolic Blood Pressure, mmHg

surgery were recorded. Group A
120 * Group B
Data were analyzed by SPSS 16 software. All data were * *
reported as means ± standard deviation (SD) for quanti- 100

tative variables and percentages for categorical variables 80

(28). One-way ANOVA and independent two-sample t-test 60
were used to confirm the effect of glucose-containing crys- 40
talloid infusion on maternal hemodynamic status. A de-
20
pendent two-sample t-test was used for comparison of the
0
variables in the two groups. P < 0.05 was considered statis- Basic 2 4 6 8 10 20 30 40 60 End
tically significant. Time, min

Figure 1. Systolic blood pressure changes, * P < 0.05

3. Results

Overall, 80 parturients participated in this study. A to- 90 Group A

Diastolic Blood Pressure, mmHg

tal of six women were excluded from the study due to a 80 Group B
BMI of more than 35 kg/m2 , 4 women due to high bleed- 70 * *
ing, whom were replaced with 10 parturients that were en- 60
rolled in the study, and finally 80 pregnant women were 50
examined with 40 in each group. 40
Demographic characteristics (age, weight, height, 30
BMI) and cause of cesarean delivery and number of preg- 20
nancies were not different between the two groups (Table 10
1). 0
There were no significant differences in intraoperative Basic 2 4 6 8 10 20 30 40 60 End

fluid infusion volume, duration of surgery, and anesthesia Time, min

and maximum sensory block level (Table 2).

Figure 2. Diastolic blood pressure changes, * P < 0.05
In the analysis of hemodynamic variables, the inci-
dence of hypotension in all women was 51.3%. Hypotension
occurred in 11 (27.5%) patients in group A and 30 (75%) in 100 Group A
Mean Blood Pressure, mmHg

group B. Incidence of hypotension in group A was signifi- 90 Group B

*
cantly lower than group B (P = 0.002). There was a statis- 80 *
tically significant difference in hypotension incidence in 70
60
time intervals of 2 (P = 0.006), 4 (P = 0.001), 6 (P = 0.005),
50
and 8 minutes (P = 0.024) after spinal anesthesia between 40
the two groups (Table 3). 30
There was a significant difference in average systolic 20
blood pressure in time intervals of 2 (P = 0.015), 4 (P = 10
0
0.001), and 6 minutes (P = 0.006) after spinal anesthesia be- Basic 2 4 6 8 10 20 30 40 60 End
tween the two groups. In other time intervals, there were Time, min
no significant differences (P > 0.05) (Figure 1).
There was a significant difference in average diastolic Figure 3. Mean blood pressure changes, * P < 0.05
blood pressure in time intervals of 4 (P = 0.009) and 6 min-
utes (P = 0.020) after spinal anesthesia between the two
groups. In other time intervals, there were no significant Bradycardia occurred in one patient (2.5%) in group A
differences (P > 0.05) (Figure 2). and one patient (2.5%) in group B (P = 0.500). There was no
There was a significant difference in average mean significant difference in heart rate in all time intervals after
blood pressure in time intervals of 4 (P = 0.003) and 6 min- spinal anesthesia between the two groups (P > 0.05) (Fig-
utes (P = 0.010) after spinal anesthesia between the two ure 4).
groups. In other time intervals, there were no significant Blood oxygen saturation decreased below 90% only in
differences (P > 0.05) (Figure 3). one patient in group B. There was no significant difference

Anesth Pain Med. 2018; 8(4):e80184. 3

 Atashkhoei S et al.

Table 1. Baseline Characteristics of All Parturients Meeting Inclusion Criteria

Group A (n = 40) Group B (n = 40) P Value

a
Age (y) 29.20 ± 5.88 29.95 ± 5.89 0.571

Weight (kg)a 75.17 ± 9.30 77.23 ± 11.85 0.389

Height (cm)a 160.50 ± 5.46 160.35 ± 5.78 0.905

BMI (kg/m2 )a 29.19 ± 3.39 29.93 ± 3.57 0.340

b
Cause of cesarean section (%) 0.344

History of cesarean 80 72.5

Others 20 27.5

Number of pregnancies (%)b 0.102

1 12.5 32.5

2 75 55

3 10 10

4 0 2.5

5 2.5 0
a
Data are presented as mean ± standard deviation.
b
Data are presented as number (%).

Table 2. Parturients’ Variables During Operation and Anesthesia Management

Group A (n = 40) Group B (n = 40) P Value

Intraoperative fluid infusion (cc)a 2091.25 ± 140.03 2109.72 ± 172.30 0.062

a
Duration of surgery (min) 50.90 ± 4.56 51.25 ± 4.78 0.736

Duration of anesthesia (min)a 65.77 ± 5.09 63.35 ± 6.60 0.070

Maximum sensory block level (%)b 0.211

T3 7.5 15

T4 52.5 42.5

T5 37.5 35

T6 2.5 37.5
a
Data are presented as mean ± standard deviation.
b
Data are presented as number (%).

in average basic oxygen saturation and in other time in-
tervals after spinal anesthesia between the two groups (P
> 0.05) (Figure 5).
In the evaluation of the incidence of other complica-
tions of spinal anesthesia, sustained hypotension, nausea,
pallor, and shivering incidence were significantly higher
in group B. There were no statistical differences in the inci-
dence of other complications between the two groups (Ta-
ble 4).
In assessing the drug used to treat the complications,
the used dose of ephedrine (P = 0.002) was significantly
higher in group B. Only one woman needed respiratory
support who was in group B (Table 4).
There was no significant difference in blood sugar level
before anesthesia and after the end of surgery in the two
groups (P > 0.05). However, both groups had increased
blood glucose levels after surgery (P = 0.001). The 1st and
5th minute APGAR score of neonates was not significantly
different between the two groups (P = 0.076). Only 3 cases
(8.9%) of the total neonates had a 1st min APGAR score of
7 or less than 7, all of which were in group B. None of the
neonates had a 5th min APGAR of less than 8 (Table 5).
4. Discussion
Many studies have been done on the prevention and
treatment of hypotension after spinal or epidural anesthe-
sia. However, there is no method that can completely pre-
vent the hypotension (15-18).

4 Anesth Pain Med. 2018; 8(4):e80184.

 Atashkhoei S et al.

Table 3. Comparison of Incidence of Hypotension in Measured Time Intervals After the group A. Consequently, complications such as sus-
Spinal Anesthesia in the Two Groupsa
tained hypotension, agitation, nausea, and pallor were
Time Group A (n = 40) Group B (n = 40) P Value lower in group A, and less ephedrine was used to treat com-
Basic 0 0 - plications in this group.
2 min 0 17.5 0.006
Nette et al. reported that glucose-containing solutions
could maintain a blood volume more than isovolemic so-
4 min 10 45 0.001
lutions (29).
6 min 20 50 0.005
Gosmanov et al. (30), also studied the effects of dex-
8 min 10 30 0.024 trose and intra-lipid infusion and found that dextrose infu-
10 min 2.5 10 0.179 sion increased blood pressure and the vascular effects that
20 min 2.5 10 0.179
were observed with dextrose infusion depended on blood
glucose concentrations.
30 min 2.5 15 0.054
Fathi et al. (4), in a study on patients undergoing
40 min 2.5 10 0.179
femoral fracture surgeries who received Hetastarch or
60 min 0 5 0.247 Ringer’s lactate solutions, showed that Hetastarch was not
End 0 0 - significantly more effective in compensation of hypoten-
a
Data are presented as number (%).
sion induced by spinal anesthesia.
Wilson et al. (31), reported that glucose infusion does
not affect the incidence of hypotension and does not facil-
102 Group A itate its treatment. Smith et al. (20), Showed that infusion
100 Group B of glucose-containing solution can reduce the duration of
98 hospitalization.
Heart Rate, Beat/min

96 Yorozu et al. (17), did not succeed in finding positive

94 effects of HES in preventing hypotension and reducing
92 ephedrine doses for treatment of hypotension after spinal
90 anesthesia, however, they found that intravenous fluid de-
88 mand in use of colloid was less than ringer lactate. They re-
86 ported that this effect was related to the higher viscosity of
84 HES compared to lactate ringer, partly due to the presence
Basic 2 4 6 8 10 20 30 40 60 End of 1% dextrose in a HES solution (17).
Time, min In a study by Brenck et al. (32), that examined the risk
factors for hypotension in pregnant women undergoing
Figure 4. Heart rate changes
cesarean section, age, body mass index, and block level
were effective factors in the prevalence of hypotension.
However, in the present study, there was no statistically sig-
Group A
nificant relationship between the above factors and the oc-
100 Group B
currence of hypotension.
99.5
By administering high-energy solutions during the
99
SPO2, %

perioperative period, glucose-based solutions have been

98.5
shown to eliminate the effects of fasting and maintain liver
98
glycogen and reduce the stress responses and increase the
97.5 insulin sensitivity of the tissues (18, 19).
97 In the present study, although blood sugar levels in-
96.5 creased after surgery, this change was within the phys-
Basic 2 4 6 8 10 20 30 40 60 End
Time, min iological range and was not significant. Fukuda et al.
(22), concluded that administration of 1% glucose, with
Figure 5. Blood oxygen saturation changes ringer acetate to women undergoing cesarean section
with epidural anesthesia, does not cause maternal hyper-
glycemia and it properly maintains the levels of blood glu-
In this study, the incidence of hypotension in all time cose in newborns.
intervals in group A was lower than group B (P = 0.002), Yatabe et al. (23), concluded that administration of 1%
which indicates improvement of hemodynamic status in glucose solution in women undergoing cesarean section

Anesth Pain Med. 2018; 8(4):e80184. 5

 Atashkhoei S et al.

Table 4. Comparison of Incidence of Complications and Treatment of Complications and Drug Dosage in the Two Groups

Group A (n = 40) Group B (n = 40) P Value

a
Complications

Sustained hypotension 2.4 31 0.001

Nausea and vomiting 2.4 26.2 0.002

Agitation 11.9 23.8 0.127

Shivering 2.4 16.7 0.029

Pallor 0 16.7 0.006

Respiratory depression 0 7.5 0.247

Bradycardia 2.4 2.4 0.753

Decreased consciousness 0 0 -
b
Treatment of complications

Ephedrine (mg) 5.11 ± 2.26 9.66 ± 3.51 0.002

Phenylephrine (µg) 50.00 ± 0.00 66.66 ± 25.81 0.145

Atropine (mg) 22.33 ± 36.95 0.50 ± 0.00 0.660

Midazolam (mg) 1.00 ± 0.00 1.06 ± 0.25 0.620

Metoclopramide (mg) 0 5.00 ± 0.00 -

Respiratory support (%)a 0 2.4 0.910

a
Data are presented as number (%).
b
Data are presented as mean ± standard deviation.

Table 5. Maternal Blood Sugar and Neonatal APGAR Score in the Two Groupsa 4.1. Conclusions
Group A (n = 40) Group B (n = 40) P Value
The findings of the present study showed that glucose-
Maternal blood containing crystalloid infusion can reduce post-spinal
sugar(mg/dL)
anesthesia hypotension and its subsequent complications.
Before the 86.45 ± 12.55 89.92 ± 11.72 0.207
surgery
Maternal blood sugar level and neonatal outcome were not
significantly different in the two groups and it shows the
After the 92.73 ± 12.83 95.94 ± 11.10 0.239
surgery safety of glucose-containing crystalloid administration.
Neonatal APGAR
score

1 min 8.97 ± 0.15 8.79 ± 12.73 0.059 References

5 min 10 9.86 ± 0.47
a
Data are presented as mean ± standard deviation.
with combined spinal-epidural is effective in preventing
hypoglycemia in neonates.
There was no significant difference between the 1st and
5th min of APGAR scores in both groups. In the Yorozu et
al. and Smith et al. studies, there was no significant dif-
ference in the outcome of newborns after administration
of glucose-containing solutions, which indicates that the
glucose-containing crystalloid infusion has no negative ef-
fect on the outcome of neonates (17, 20).
0.076
1. Imani F, Entezary SR, Alebouyeh MR, Parhizgar S. The maternal and
neonatal effects of adding tramadol to 2% lidocaine in epidural
anesthesia for cesarean section. Anesth Pain Med. 2011;1(1):25–9. doi:
10.5812/kowsar.22287523.1271. [PubMed: 25729652]. [PubMed Central:
PMC4335753].
2. Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ,
et al. International consensus statement on the management of hy-
potension with vasopressors during caesarean section under spinal
anaesthesia. Anaesthesia. 2018;73(1):71–92. doi: 10.1111/anae.14080.
[PubMed: 29090733].
3. Zieleskiewicz L, Noel A, Duclos G, Haddam M, Delmas A, Bechis C, et
al. Can point-of-care ultrasound predict spinal hypotension during
caesarean section? A prospective observational study. Anaesthesia.
2018;73(1):15–22. doi: 10.1111/anae.14063. [PubMed: 28986931].
4. Fathi M, Imani F, Joudi M, Goodarzi V. Comparison between the effects
of ringer’s lactate and hydroxyethyl starch on hemodynamic param-
eters after spinal anesthesia: A Randomized Clinical Trial. Anesth Pain
Med. 2013;2(3):127–33. doi: 10.5812/aapm.7850. [PubMed: 24244923].
[PubMed Central: PMC3821133].

6 Anesth Pain Med. 2018; 8(4):e80184.

 Atashkhoei S et al.
5. Chestnut DH, Polley LS, Wong CA, Tsen LC. Chestnut’s obstetric anesthe-
sia: principles and practice. 4th ed. Philadelphia: Elsevier Health Sci-
ences; 2009.
6. Quan ZF, He HL, Tian M, Chi P, Li X. Influence of lateral decubitus posi-
tioning after combined use of hyperbaric and hypobaric ropivacaine
on hemodynamic characteristics in spinal anesthesia for caesarean
section. Int J Clin Exp Med. 2014;7(12):5669–74. [PubMed: 25664088].
[PubMed Central: PMC4307535].
7. Yurtlu BS, Hanci V, Okyay RD, Bostankolu SE, Kayhan GE, Hakimoglu,
S , et al. Effects on hypotension incidence: hyperbaric, isobaric, and
combinations of bupivacaine for spinal anesthesia in cesarean sec-
tion. Turk J Med Sci. 2012;42(2):307–13. doi: 10.3906/sag-1010-1258.
8. George RB, McKeen DM, Dominguez JE, Allen TK, Doyle PA, Habib AS. A
randomized trial of phenylephrine infusion versus bolus dosing for
nausea and vomiting during Cesarean delivery in obese women. Can
J Anaesth. 2018;65(3):254–62. doi: 10.1007/s12630-017-1034-6. [PubMed:
29209926]. [PubMed Central: PMC5856192].
9. Ayorinde BT, Buczkowski P, Brown J, Shah J, Buggy DJ. Evaluation of
pre-emptive intramuscular phenylephrine and ephedrine for reduc-
tion of spinal anaesthesia-induced hypotension during Caesarean
section. Br J Anaesth. 2001;86(3):372–6. [PubMed: 11573527].
10. Bhat MA, Buchh VN, Gurcoo SA, Nazir I, Qazi S. Comparison between
phenylephrine and ephedrine in preventing hypotension during
spinal anesthesia for cesarean section. J Obst Anaesth Critical Care.
2012;2(2):92. doi: 10.4103/2249-4472.104734.
11. Wang X, Xu JM, Zhou F, He L, Cui YL, Li ZJ. Maternal position and devel-
opment of hypotension in patients undergoing cesarean section un-
der combined spinal-epidural anesthesia of intrathecal hyperbaric
ropivacaine. Med Sci Monit. 2015;21:52–8. doi: 10.12659/MSM.892224.
[PubMed: 25557016]. [PubMed Central: PMC4292763].
12. Hirose N, Kondo Y, Maeda T, Suzuki T, Yoshino A. Relationship be-
tween regional cerebral blood volume and oxygenation and blood
pressure during spinal anesthesia in women undergoing cesarean
section. J Anesth. 2016;30(4):603–9. doi: 10.1007/s00540-016-2165-6.
[PubMed: 27011334].
13. Nishikawa K, Yokoyama N, Saito S, Goto F. Comparison of effects of
rapid colloid loading before and after spinal anesthesia on mater-
nal hemodynamics and neonatal outcomes in cesarean section. J
Clin Monit Comput. 2007;21(2):125–9. doi: 10.1007/s10877-006-9066-4.
[PubMed: 17265094].
14. Rout CC, Rocke DA, Levin J, Gouws E, Reddy D. A reevaluation of the
role of crystalloid preload in the prevention of hypotension associ-
ated with spinal anesthesia for elective cesarean section. Anesthesiol-
ogy. 1993;79(2):262–9. [PubMed: 8192733].
15. Teoh WH, Sia AT. Colloid preload versus coload for spinal anesthe-
sia for cesarean delivery: the effects on maternal cardiac output.
Anesth Analg. 2009;108(5):1592–8. doi: 10.1213/ane.0b013e31819e016d.
[PubMed: 19372341].
16. Tamilselvan P, Fernando R, Bray J, Sodhi M, Columb M. The effects
of crystalloid and colloid preload on cardiac output in the par-
turient undergoing planned cesarean delivery under spinal anes-
thesia: a randomized trial. Anesth Analg. 2009;109(6):1916–21. doi:
10.1213/ANE.0b013e3181bbfdf6. [PubMed: 19923521].
17. Yorozu T, Morisaki H, Kondoh M, Zenfuku M, Shigematsu T. Compar-
ative effect of 6% hydroxyethyl starch (containing 1% dextrose) and
lactated Ringer’s solution for cesarean section under spinal anesthe-
sia. J Anesth. 2002;16(3):203–6. doi: 10.1007/s005400200025. [PubMed:
14517641].
18. Shrivastava VK, Garite TJ, Jenkins SM, Saul L, Rumney P, Preslicka C,
et al. A randomized, double-blinded, controlled trial comparing par-
Anesth Pain Med. 2018; 8(4):e80184.
enteral normal saline with and without dextrose on the course of
labor in nulliparas. Am J Obstet Gynecol. 2009;200(4):379 e1–6. doi:
10.1016/j.ajog.2008.11.030. [PubMed: 19217592].
19. Sharma C, Kalra J, Bagga R, Kumar P. A randomized controlled trial
comparing parenteral normal saline with and without 5% dextrose
on the course of labor in nulliparous women. Arch Gynecol Ob-
stet. 2012;286(6):1425–30. doi: 10.1007/s00404-012-2485-1. [PubMed:
22865033].
20. Smith MD, McCall J, Plank L, Herbison GP, Soop M, Nygren J. Preop-
erative carbohydrate treatment for enhancing recovery after elec-
tive surgery. Cochrane Database Syst Rev. 2014;(8). CD009161. doi:
10.1002/14651858.CD009161.pub2. [PubMed: 25121931].
21. Jamal A, Choobak N, Tabassomi F. Intrapartum maternal glucose infu-
sion and fetal acid-base status. Int J Gynaecol Obstet. 2007;97(3):187–9.
doi: 10.1016/j.ijgo.2007.01.016. [PubMed: 17368645].
22. Fukuda I, Matsuda H, Sugahara S, Kazama T. The effect of intra-
venous glucose solutions on neonatal blood glucose levels after ce-
sarean delivery. J Anesth. 2013;27(2):180–5. doi: 10.1007/s00540-012-
1516-1. [PubMed: 23143044]. [PubMed Central: PMC3622020].
23. Yatabe T, Tateiwa H, Ikenoue N, Kitamura S, Yamashita K, Yokoyama M.
Influence of administration of 1 % glucose solution on neonatal blood
glucose concentration in cesarean section. J Anesth. 2013;27(2):302–5.
doi: 10.1007/s00540-012-1512-5. [PubMed: 23132181].
24. Ngan Kee WD. Prevention of maternal hypotension after re-
gional anaesthesia for caesarean section. Curr Opin Anaesthesiol.
2010;23(3):304–9. doi: 10.1097/ACO.0b013e328337ffc6. [PubMed:
20173633].
25. Mercier FJ. Cesarean delivery fluid management. Curr Opin Anaesthe-
siol. 2012;25(3):286–91. doi: 10.1097/ACO.0b013e3283530dab. [PubMed:
22459983].
26. Mercier FJ, Augè M, Hoffmann C, Fischer C, Le Gouez A. Maternal hy-
potension during spinal anesthesia for caesarean delivery. Minerva
Anestesiol. 2013;79(1):62–73.
27. Arora P, Singh RM, Kundra S, Gautam PL. Fluid administration be-
fore caesarean delivery: Does type and timing matter? J Clin Diagn
Res. 2015;9(6):UC01–4. doi: 10.7860/JCDR/2015/12083.6008. [PubMed:
26266190]. [PubMed Central: PMC4525580].
28. Faiz SH, Rahimzadeh P, Imani F, Bakhtiari A. Intrathecal injection
of magnesium sulfate: shivering prevention during cesarean sec-
tion: a randomized, double-blinded, controlled study. Korean J Anes-
thesiol. 2013;65(4):293–8. doi: 10.4097/kjae.2013.65.4.293. [PubMed:
24228140]. [PubMed Central: PMC3822019].
29. Nette RW, Krepel HP, van den Meiracker AH, Weimar W, Zietse R.
Specific effect of the infusion of glucose on blood volume during
haemodialysis. Nephrol Dial Transplant. 2002;17(7):1275–80. [PubMed:
12105252].
30. Gosmanov AR, Smiley DD, Peng L, Siquiera J, Robalino G, New-
ton C, et al. Vascular effects of intravenous intralipid and dex-
trose infusions in obese subjects. Metabolism. 2012;61(10):1370–6. doi:
10.1016/j.metabol.2012.03.006. [PubMed: 22483976]. [PubMed Central:
PMC3738183].
31. Wilson D, Douglas J, Heid R, Rurak D. Preoperative dextrose does
not affect spinal-induced hypotension in elective Cesarean section.
Can J Anaesth. 1999;46(11):1024–9. doi: 10.1007/BF03013196. [PubMed:
10566921].
32. Brenck F, Hartmann B, Katzer C, Obaid R, Bruggmann D, Benson M, et
al. Hypotension after spinal anesthesia for cesarean section: identifi-
cation of risk factors using an anesthesia information management
system. J Clin Monit Comput. 2009;23(2):85–92. doi: 10.1007/s10877-009-
9168-x. [PubMed: 19277879].
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